Uso de ácido tranexámico en las hemorragias / Use of traxenamic acid in hemorrhages

RESUMEN Según las evidencias científicas actuales, la administración de un tratamiento simple y económico con propiedades antifibrinolíticas, como el ácido tranexámico pudiera reducir la pérdida sanguínea luego de un trauma y disminuir el riesgo asociado a transfusiones sanguíneas. El ácido tranexámico es un derivado sintético de la lisina con una actividad antifibrinolítica pura. Su mecanismo de acción se basa en la unión al enlace de la lisina del plasminógeno, lo que bloquea la unión de la fibrina al complejo activador del plasminógeno-plasmina.Ante tal evidencia, esta revisión se propone describir los resultados del empleo del ácido tranexámico según la evidencia disponible. Para ello se realizó una búsqueda en bases de datos como PubMed, SciELO y ClinicalKeys(AU)

ABSTRACT According to the present scientific evidence, the administration of a simple economic treatment with anti-fibrinolytic properties such as the tranexamic acid can reduce the blood loss after trauma, and decrease the risk associated to blood transfusions. Tranexamic acid is a synthetic derivative of lysine with pure anti-fibrinolytic activity. Its mechanism of action is based on the joining to the plasminogen lysine bond, which blocks the binding of fibrin to the activating complex of plasminogen-plasmin. This review was aimed at describing the results of the use of tranexamic acid based on available evidence. To this end, a literature search was made in PubMed, SciELO and Clinical Keys databases(AU)

Clinical features of patients with massive transfusion during plastic surgery / 中华医学美学美容杂志

Objective To review the clinical features of the patients received massive transfusion (MT) in plastic surgery department.Methods Ten cases were reviewed.The reason of massive transfusion,the type and dosage of transfusion,the reaction of patients were included.For all the patients,consultation of related department preoperatively was necessary.Based on the through and detailed analysis of the patients' condition,necessary blood product should be prepared ahead of operation.During the therapy,adjustment of treatment plan was made from time to time,according to the patient's condition.Therefore efficient and prompt therapeutic result was achieved.Results In all the 10 MT cases suffered from acute blood loss,2 of them were in hemorrhagic shock before administration.Coagulation disorders happened in 2 patients,and recovered after appropriate treatment.RBC,which was 58.3％ of total amount of transfusion,used most commonly;the second was fresh frozen plasma (FFP),which was 38.6％ according to the total amount.All the patients had satisfactory recovery,without hemolysis or any other functional disorder.Conclusions For MT patients in the Department of Plastic Surgery,the main proposes are to restore and maintain an effective circulatory blood volume,while preventing the coagulation disorder.Also,detailed analysis,through consultation and timely adjustment are of great importance for the MT patients.It is also the essential of an effective perioperative management.

Influence of surgical intervention on the prognosis of patients with acute hemorrhage necrotizing pancreatitis / 中国基层医药

Objective To explore the effect of surgical intervention on the prognosis of patients with acute hemorrhage necrotizing pancreatitis.Methods The clinical data of 66 patients with acute hemorrhage necrotizing pancreatitis were analyzed retrospectively and divided into two groups:operation group (50 cases) and expectant treatment group( 16 cases).The secondary infection rate,hospitalized duration,hospitalization cost and healing rate were compared between the two groups.Results The secondary infection rate,hospitalized duration,hospitalization cost and healing rate of the operation group was significantly better than that of the expectant treatment group( x2 =5.38,5.56,t =24.65,6.46,all P ＜ 0.05 ).Conclusion Surgical intervention could obviously improve the outcomes and cut down the medical cost.

Intravenous administration of vitamin K as an effective treatment for a patient with systemic hemorrhage: a case report

A man in his 60s, who was diagnosed as having postoperative recurrent gastric cancer with lymph node and spinal metastases, was admitted to our palliative care unit (PCU). He was unable to receive further aggressive chemotherapy for cancer because of bilateral hydronephrosis and chronic renal failure. He had chronic urethral infection and hence required continuous antibiotic administration. Although his infection was well controlled with antibiotics, his oral intake gradually declined. Seventeen days after admission, he developed systemic hemorrhage, including hematuria and oral bleeding. Coagulation tests revealed that the patient had markedly prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) but no thrombocytopenia, fibrinogen consumption, or increased fibrin/fibrinogen degradation products (FDP) level. Serum level of protein induced by vitamin K absence or antagonist II (PIVKA-II) was markedly high, and vitamin K level was below the lower limit of the reference range. After he was administered intravenous vitamin K, his symptoms markedly improved. Many patients with advanced cancers tend to have malnutrition, anorexia, and chronic infection that require antibiotic administration. Prophylactic administration of vitamin K might be sometimes necessary for preventing catastrophic hemorrhage.

The expression of CD62p and cytokines in acute hemorrhage patients with systemic inflammatory response syndrome and the influence on prognosis / 中国综合临床

Objective To study the expression of eytokines in acute hemorrhage patients with systenlic in-flammatory response syndrome(SIRS)and multiple organ dysfunction syndrome(MODS).Methods Platelet acti-vation markers CD62p and cytokines in acute hemorrhage patients with SIRS and MODS were detected by using flow cytometry,and compared with that of control group.Results The expression of CD62p and cytokines(TNF-α and IL-6)in acute hemorrhage patients,with or without SIRS and MODS wag significantly higher than that in control group(P<0.01),and higher in MODS group than in SIRS group,and in MODS death group than in MODS survival group(P<0.01).Conclusion The activation of platelet and the over-expression of cytokines participate in the on-set and development of acute hemorrhage,SIRS and MODS,and were related with the severity of disease and progno-sis.

Phospholipase A2 Contributes to Hemorrhage-induced Acute Lung Injury Through Neutrophilic Respiratory Burst / 결핵

BACKGROUND: The present study was carried out in association with neutrophilic respiratory burst in the lung in order to clarify the pathogenesis of acute respiratory distress syndrome(ARDS) following acute severe hemorrhage. Because oxidative stress has been suggested as one of the principal factors causing tissue injury, the role of free radicals from neutrophils was assessed in acute hemorrhage-induced lung injury. METHOD: In Sprague-Dawley rats, hemorrhagic shock was induced by withdrawing blood(20 ml/kg of B.W) for 5 min and the hypotensive state was sustained for 60 min. To determine the mechanism and role of oxidative stress associated with phospholipase A2(PLA2) by neutrophils, the level of lung leakage, pulmonary myeloperoxidase(MPO), and the pulmonary PLA2 were measured. In addition, the production of free radicals was assessed in isolated neutrophils by cytochemical electron microscopy in the lung. RESULTS: In hypotensive shock-induced acute lung injury, the pulmonary MPO, the level of lung leakage and the production of free radicals were higher. The inhibition of PLA2 with mepacrine decreased the pulmonary MPO, level of lung leakage and the production of free radicals from neutrophils. CONCLUSION: A. neutrophilic respiratory burst is responsible for the oxidative stress causing acute lung injury followed by acute, severe hemorrhage. PLA2 activation is the principal cause of this oxidative stress.

The Predictors of the Change of Cardiac Output and the Changes of Electrolyte in the Acute Hemorrhagic Dogs / 대한마취과학회지

BACKGROUND: We designed this study to compare acid-base parameter with hemodynamic parameter as the predictor of acute blood loss. And we tried to evaluate the changes of electrolyte and to correlate the change of each parameter with that of cardiac output (CO) during acute blood loss. METHODS: Seven anesthetized (isoflurane 1.0-1.5%), paralyzed and mechanically constant ventilated dogs submitted to hemorrhage were studied. The dogs were hemorrhaged by progressive withdrawal of 50% of blood volume. After withdrawal of each 10% of blood volume mean arterial blood pressure (MAP), CO, arterial blood gas analysis, electrolytes and hematocrit (Hct) were measured. RESULTS: MAP, pH, PaCO2, PaO2 and base excess (BE) were decreased significantly according to hemorrhage and correlated with the percent decrease in CO. Serum sodium concentration and calcium concentration were not changed. Serum potassium concentration was increased and Hct was decreased significantly and correlated with the percent decrease in CO. Correlation between BE and percent decrease in CO (r=0.771) was superior to the correlations between any other parameter and percent decrease in CO. CONCLUSION: More negative BE is the best indicator of ongoing hemorrhage. Thus BE may be the best laboratory monitor of hemorrhage and the evaluation of acid-base state and the changes of serum potassium concentration are important in the acute hemorrhagic situation.

Experimental Study on DMAP used in the Combined Injury of Acute Hemorrhage and Cyanide Intoxication in Dogs / 第三军医大学学报

The animal models of the combined injuries of mild, medium or severe hemorrhage and cyanide intoxication were produced by bleeding to 9.33, 6.67, or 5.33 kPa of arterial systolic pressure and administrating NaCN 2.5 mg/kg intravenously. Dogs with the combined injury of acute mild hemorrhage and cyanide intoxication in control group did not receive DMAP treatment whereas dogs in DMAP treatment groups receiveed DMAP 2 mg/kg iv at 3 min after administrating cyanide. The changes of hemodynamics and blood gases and methemoglobin were determined. The dogs receiving no DMAP treatnent in control group died within 5 min after intoxication. DMAP has an excitatory effect on hemodynamics after giving to dogs with the combined injury of acute mild hemorrhage and cyanide intoxication. It can save the dogs from death. The excitatory effect of DMAP on hemodynamics becomes weaker while the level of acute hemorrhage increases. The results of blood gas and methemoglobin analysis indicated that DMAP can disturb the oxygen-carrying capacity of hemoglobin because of the formation of much higher concentration of methemoglobin when DMAP is used as an antidote for the combined injury of acute hemorrhage and cyanide intoxication. The results suggested that methemoglobin formers should not be used as the antidotes for the combined injury of acute hemorrhage and cyanide intoxication.